Exploring the Clinical Outcomes of Implementing Diabetes Self-Management Education and Support in a Primary Care Practice: A Quality Improvement Project.

Abstract

Introduction/Purpose: Diabetes self-management education and support (DSMES) can be a very valuable service for many patients with diabetes. Unfortunately, despite its expected benefits, many patients do not receive DSMES through a quality, structured program. The purpose of this quality improvement project was to determine if integrating a diabetes education program utilizing the Association of Diabetes Care and Education Specialists (ADCES)7 Self-Care Behaviors into diabetes care in a primary care clinic could improve glycemic control and body mass index (BMI). Methods: The DSMES services provided were in accordance with the ADCES and the American Diabetes Association National Standards. The program included a 1-hour face-to-face service incorporating the ADCES7 Self-Care behaviors. A retrospective chart review was conducted to extract outcome data from N = 54 random medical records. This data was then analyzed to evaluate the program's effectiveness. Pre- and postintervention data from medical records were analyzed for eligible patients who participated in the DSMES service (ages 18-75 with type 2 diabetes, hemoglobin A1c [A1c] >8%). Results: Paired t tests were used to determine significant changes in BMI and A1c parameters pre- and postintervention. Preintervention A1c (M = 9.5, SD = 1.7) and BMI (M = 33.2, SD = 7.8) and postintervention A1c (M = 7.8, SD = 1.5) and BMI (M = 32.2, SD = 7.9) indicate that DSMES significantly reduced A1c, t(53) = 8.1, p = <.001, and BMI, t(53) = 4.4, p = <.001. Models were then adjusted for pretest measures, age, gender, and time since diagnosis in a regression analysis. In models adjusted for pretest measures, age, gender, and time since diagnosis was significantly predictive of the postmeasure of BMI (B = .41, p = .01, R2 = .96) and postmeasure of A1c (B = .28, p = .04, R2 =.41). Discussion: This project demonstrated that integrating a simple, cost-effective diabetes education service consisting of ADCES7 Self-Care Behaviors in a primary care practice could bridge gaps in diabetes management and significantly improve patients' BMI and A1c. Long-term utilization of this service may also enhance patient satisfaction, improve the patient's health, and reduce healthcare costs related to diabetes.